Dr Fiona Riordan is a Senior Postdoctoral Researcher in the School of Public Health, UCC. Her research interests include implementation science, quality improvement, integrated care, and chronic disease management in primary care. Currently Fiona works on the CUSTOMISE project, which aims to explore the process and impact of tailoring strategies to implement evidence-based interventions. In 2021 she has been working on the LINK project, to understand the implementation of a local befriending service during the COVID-19 pandemic, including how it links in with community healthcare services. Fiona has a PhD in Health Services Research, and a Masters in Public Health.
Evidence-based patient education programmes like DAFNE, which is prioritised for national implementation in Ireland, are recommended as part of diabetes management. However, little is known about current DAFNE implementation and how best to support delivery. Tailoring typically involves determinant identification, prioritisation, and selection of strategies, but how best to combine evidence, theory and stakeholder perspectives during prioritisation and selection is unclear[1,2]. To address this gap, we are 1) working with Irish DAFNE centres to tailor strategies, 2) evaluating the tailoring process, including how clinical stakeholders use evidence and guidance.
To identify potential determinants, we (a) undertook a rapid review of structured diabetes education programmes and coded to CFIR (b) are analysing data from 91 Irish and UK DAFNE centres). DAFNE teams will complete a survey on their site characteristics (implementation culture, climate, readiness) before taking part in three group sessions to identify and prioritise determinants and select strategies. First, participants prioritise determinants and select strategies based on their own assumptions, needs and preferences. Then they will consider guidance (including feasibility of addressing a determinant, importance, ubiquity, chronicity, and criticality), determinant-strategy alignment of strategies, and evidence of strategy effectiveness. Participants’ experiences of the tailoring process will be evaluated via research logs, non-participant observation, surveys, and post-tailoring interviews.
During 2019-2021 91 centres delivered 1257 courses (2 to 74 courses across centres) and 6749 people attended; 9.5% dropped out. Determinants identified included: lack of available resources (e.g., staff schedules), access to knowledge and information (e.g., staff preparation) and networking and communication (e.g., staff experience working with one another). For the next stage, we have invited 18 sites to participate in the tailoring process
This study will advance our current understanding of tailoring, including clinical stakeholder decision-making during the process, and what is feasible and sustainable for them in practice